tbuckley/cabot-search huggingface dataset:
Abstract 13233: Covid Related Thrombus or Vasculitis?
Authors: Prama Rashmi, Prakrity Urja
Journal: Circulation (2022)

COVID is associated with cardiovascular manifestations. It worsens the pre-existing cardiovascular diseases, and newly diagnosed cardiovascular diseases are being reported with it. In our abstract we present a case with unusual cardiac manifestation with COVID. 63-years-old, covid positive male with hypertension, hyperlipidemia and coronary artery disease with prior RCA stent was admitted for inferior STEMI.The angiogram showed instent stenosis, with distal vessels narrowing. Stent was placed in RCA. Despite this, he had persistent chest pain and ST elevation, so he was taken back to Cath lab. It confirmed patent stent. For distal vessel narrowing with ongoing pain intra-aortic balloon pump was placed. Aggrastat and heparin was continued. At the time of discharge, he had ongoing dyspnea and chest pain, which was thought to be associated with COVID. He was readmitted in six days for pericardial effusion with constriction and echocardiographic finding of tamponade. He had elevated inflammatory markers and liver enzyme. With recent COVID infection, elevated inflammatory markers, echo findings and known distal coronary artery narrowing there was a concern of vasculitis and pericarditis. He was started on steroid and colchicine with significant improvement. COVID can cause direct myocardial injury or indirect injury due to altered myocardial demand-supply. The pericardial involvement is associated with heightened inflammation and increased vascularity. Interestingly, our patient who initially presented as ACS had resolution of symptoms with steroids. Could ACS symptoms not resolving with antiplatelets and stenting be a part of inflammatory picture of COVID? In post-COVID autopsy and surgical tissue diffuse lymphocytic endotheliitis and apoptotic bodies are seen in the vascular beds. Vasculitis lesion in skin and Kawasaki’s disease is reported in adolescents and children. However, adult-onset vasculitis is still to be studied.
Abstract 13709: Cardioprotective Mechanisms of FTO-Regulated m <sup>6</sup> A in Heart Failure
Authors: Anh Phan, Prabhu Mathiyalangan, Susmita Sahoo
Journal: Circulation (2022)

Introduction: Post-transcriptional modifications of mRNA play an important role in cardiac remodeling. We recently reported an aberrant increase in global N6-methyladenosine (m 6 A) in failing hearts associated with reduction in expression of m 6 A eraser, fat and obesity-associated protein (FTO). Overexpression of FTO increased m 6 A, and improved cardiomyocyte and cardiac function in both in vitro and in vivo models for myocardial infarction (MI). Here, we investigated the mRNA targets of FTO and mechanism of FTO-dependent cardiac protein expression in failing hearts. Hypothesis: We hypothesized that FTO mediates cardioprotection via demethylation of selective mRNA transcripts in the nucleus and cytoplasm of cardiomyocytes. Methods and Results: To identify subcellular localization of FTO-mRNA interaction, we examined FTO expression in human left ventricular cardiomyocytes under hypoxia in vitro and in mouse and human failing hearts in vivo . FTO was detected in both nucleus and cytoplasm of healthy cardiomyocytes and tissues, but not in hypoxic cardiomyocytes and MI mouse and human heart tissues. To reveal functional targets of FTO, we performed m 6 A RNA sequencing of nuclear and cytoplasmic RNA in cultured human cardiomyocytes. We identified distinct sets of RNA transcripts in nucleus and cytoplasm of cardiomyocytes involved in cardiac contraction, angiogenesis, cardiomyogenesis, hypermethylated by FTO. Methylated RNA immunoprecipitation experiments revealed that SERCA2a (involved in cardiomyocytes contraction) and FSTL1 (pro-angiogenic) mRNAs directly bind to FTO. Loss of FTO resulted in decreased nuclear export of SERCA2a and FSTL1 mRNAs. Our stable isotope labeling (SILAC) experiment confirmed that FTO regulates de-novo synthesis of SERCA2A and FSTL1 proteins. Conclusion: We conclude that FTO selectively targets the cardioprotective transcripts, regulates their nuclear export and protein expression. Our study will reveal FTO binding sites on cardiac transcripts and a novel mechanism of FTO-dependent protein expression in cardiomyocytes.
Abstract 13191: Leukocytoclastic Vasculitis and Acute Renal Failure as a Sign of Infective Endocarditis: A Case Report
Authors: Rahul Bussa, Fiyad Haniff, Mohammad Ahmed, Alia Chisty
Journal: Circulation (2022)

Case Presentation: Infective endocarditis (IE) can sometimes be a diagnostic challenge because its presentation in its early stages may coincide with that of several other disease processes. It has an incidence of ~7 per 100,000 annually yet has an in-hospital mortality of about 20-25%. We present a case of a 56-year-old immunocompetent male with a recent diagnosis of leukocytoclastic vasculitis (LCV) who was admitted for acute renal failure (ARF). With his history of LCV (Figure 1), renal vasculitis was thought to be contributing to his ARF. On admission, he was afebrile and had a creatinine of 5.25 (baseline of 0.8), hyponatremia, anemia, mild leukocytosis, and mildly elevated lactate. No other infectious sequelae were noted. Nephrology was consulted for workup of renal failure, and a renal biopsy was recommended. Before the biopsy was able to be performed, blood cultures returned positive for Enterococcus faecalis. Transesophageal echocardiogram revealed a large, mobile 1.3-centimeter vegetation attached to the left ventricular outflow tract side of the non-coronary cusp of the aortic valve. Parenteral antibiotics were initiated, and cardiothoracic surgery was consulted for surgical correction. The patient ultimately underwent aortic valve replacement successfully with renal recovery to baseline and resolution of his leukocytoclastic vasculitis soon thereafter. Discussion: LCV has been established as a rare, but well-reported sign of IE. Similarly, only a few cases of IE presenting as ARF have been reported. In patients presenting with both LCV and ARF, it is important to maintain a high index of suspicion for IE. Going down the pathway to work up renal vasculitis may unnecessarily expose patients to invasive procedures, incorrect treatment modalities, and other complications.
Abstract 13117: Gender Parity in High Impact Cardiology Journals
Authors: Oksana Petrechko, Andrew Faturos, Umair A Khan, Shazib Sagheer, Suman Pal, Rahul Shekhar, Eileen Barrett, Abu Baker B Sheikh
Journal: Circulation (2022)

Background: Despite advances in representation of women in medical training, women continue to be underrepresented in cardiology, particularly in senior roles of authorship and leadership. Analyzing trends in high-impact cardiology journals can highlight underrepresentation of women and help elucidate barriers to female representation in academic cardiology. Methods and Results: Using the SCImago Journal and Country Rank (SCR), we analyzed 20 journals (31,540 total articles) in cardiology and cardiovascular medicine with the highest total citations from January 1 st 2018 to October 31 st 2021 for gender distribution of editorial staff and authorship. Gender of individuals was classified using biographical information from public and personal media sources. In cases of ambiguity, Genderize.io was used to help predict gender at probability of ≥95%. Our data demonstrated that 27% of articles had women as first authors and 20% as senior authors. Men constituted the majority of both first authors (73%) and senior authors (80%). The editorial staff was 77% men, with women accounting for 23%. Only 10% of editors-in-chief were women. There was a statistically significant negative correlation between the percentage of women first authors and percentage of men on the editorial board. There was no statistical significance between journal impact factor and percentage of men and women as authors. Overall, female authorship increased from 26% first and 19% senior authors in 2018 to 29% first and 22% senior authors in 2021. Conclusion: Women are significantly under-represented in the field of cardiology as first or senior authors, editorial board members, and editors-in-chief in the top medical journals. Although there has been a slight uptrend in percentage of women occupying leading publishing roles, parity with men is still a work in progress. Additional work is needed to identify and address barriers to publishing and academic advancement for women physicians in cardiology.
Abstract 14396: Periprocedural Myocardial Injury After Elective Percutaneous Coronary Intervention is Associated With Excess Long-Term Mortality
Authors: Nina Talmor, sam kozloff, Vincent J Major, Binita Shah, Anvar Babaev, Louai Razzouk, Michael Attubato, Frederick Feit, James Slater, Nathaniel Smilowitz
Journal: Circulation (2022)

Introduction: Periprocedural myocardial injury (pMI), characterized by elevations in circulating cardiac biomarkers, is common following percutaneous coronary intervention (PCI) for stable ischemic heart disease. We sought to characterize incidence, risk factors, and long-term outcomes of pMI early after PCI. Methods: Patients who underwent elective PCI at a large academic medical center between 2011 and 2020 were included in this retrospective, observational study. We characterized patient and procedural characteristics from local submissions to the NCDR CathPCI registry. All patients underwent routine measurements of CK-MB at 1 and 3 hours post-PCI. Patients with abnormal CK-MB or troponin pre-PCI were excluded. For patients with multiple PCI, only the first PCI was included in the analysis. pMI was defined as any post-PCI CK-MB &gt;99th percentile upper reference limit of the assay. The primary outcome was all-cause mortality derived from the Social Security Administration Death Master File. Cox proportional hazards models were generated to estimate the hazard of mortality associated with pMI. Results: We identified 10,923 patients undergoing elective PCI with routine post-PCI CK-MB measurement, with 47,959 patient-years of follow-up (mean: 4.4 years, range: 0 - 9.7). pMI occurred in 1843 cases (16.9%). Patients with pMI were older, more likely to be men, and had a higher burden of cardiovascular risk factors compared to those without pMI ( Table ). Over long-term follow-up, 483 patients (4.4%) died. Long-term, all-cause mortality was higher among patients with versus without pMI (8.0% vs. 3.7%, p&lt;0.001). After adjustment for age and sex, pMI was associated with an excess hazard for long-term mortality (hazard ratio 1.48, 95% CI 1.22-1.80). Conclusion: Myocardial injury detected early after PCI is common and is associated with increased long-term all-cause mortality. Efforts to reduce pMI incidence are needed.
Abstract 14132: Comparison of Right Anterior Mini-Thoracotomy versus Partial Upper Sternotomy in Aortic Valve Replacement
Authors: Saad Salamate
Journal: Circulation (2022)

Introduction: Propensity score analysis of midterm outcomes after isolated aortic valve replacement through right anterior mini-thoracotomy and partial upper sternotomy could provide information about the most beneficial minimally invasive technique for the patient based on the preoperative risk factors. Hypothesis: Can the right anterior mini-thoracotomy be used as first line surgical access for aortic valve replacement? Methods: Between March 2015 and February 2021, 694 minimally invasive isolated aortic valve surgery were performed at our institution. Among these, 441 right anterior mini-thoracotomies and 253 partial upper sternotomies were performed. A propensity score analysis was performed in 202 matched pairs. Results: Cardiopulmonary bypass time and cross clamp time were significantly shorter in right anterior mini-thoracotomy group than in the partial upper sternotomy group ( p =0.001 and p &lt;0.001, respectively). Time to first mobilization and hospital stay were significantly shorter in the right anterior mini-thoracotomy group than in the partial upper sternotomy group ( p =0.005, p =0.001, respectively). A significantly lower incidence of revision surgery was noted in the right anterior mini-thoracotomy group than in the partial upper sternotomy group ( p =0.046). No significant differences in 30-day mortality ( p =1.000) and 1-year mortality ( p =0.543) were noted. Kaplan-Meier survival estimates were 96.3 % in right anterior mini-thoracotomy group and 92.7 % in the partial upper sternotomy group after 4 years (log rank 0.169), respectively. Conclusions: Despite the technical challenges, right anterior mini-thoracotomy can be chosen as first-line strategy for the isolated aortic valve replacement. For patients unsuitable for this technique, the partial upper sternotomy remains a safe method that can be performed by a wide range of surgeons.
Abstract 13952: Incidence of In-Hospital Cardiac Arrest and Associated In-Hospital Mortality in Pediatric Critically Ill Patients With Cardiac Disease Significantly Decreased Over Time: Results From a Systematic Review and Meta-Analysis
Authors: Francesca Sperotto, Marco Daverio, Dario Gregor, Anna Dorste, Catherine K Allan, angela amigoni, Ravi R Thiagarajan
Journal: Circulation (2022)

Introduction: Studies evaluating trends in the incidence and mortality for in-hospital cardiac arrest (IHCA) in children with cardiac disease admitted to the intensive care unit (ICU) are rare. Additionally, there is limited information on factors associated with IHCA and mortality. Hypothesis: We hypothesized that the incidence of IHCA and the mortality rate in cardiac children admitted to the ICU has significantly decreased over time. Methods: We conducted a systematic review of PubMed, Web of Science, EMBASE, and CINAHL from inception to Sept 2021. Random effects meta-analysis was used to compute pooled-proportions and pooled-ORs. Meta-regression adjusted for type of study (registry vs cohort) and diagnostic category (surgical vs general cardiac) was used to evaluate trends in incidence and mortality. Results: Of the 2,574 studies identified, 25 were included in the systematic review (126,087 patients), 18 in the meta-analysis. Five percent (95% CI: 4-7%) of ICU children experienced IHCA and 35% (95% CI: 27-44%) did not achieve ROSC. In centers with ECMO, 21% (95% CI: 15-28%) underwent ECPR. The pooled in-hospital mortality was 54% (95% CI: 47-62%). Both incidence of IHCA and in-hospital mortality decreased significantly in the last 20 y (p&lt;0.001, Figure 1, and p=0.020, respectively), while the proportion of patients achieving ROSC did not change (p=0.572). Neonatal age, prematurity, comorbidities, univentricular physiology, arrhythmias, pre-arrest mechanical ventilation, ECMO, and higher surgical complexity increased IHCA and mortality odds. Conclusions: A significant proportion (5%) of cardiac children in the ICU experience IHCA. Decreasing trends in IHCA and in-hospital mortality suggests that education on preventive measures and post-arrest care have been effective. However, unchanged proportion of patients not achieving ROSC illustrates the crucial need for developing resuscitation strategies specific to children with cardiac disease.
Abstract 14007: Sodium-Dependent Glucose Transporters 2 Inhibition Ameliorates Obesity-Induced Metabolic Changes and Cardiomyopathy
Authors: Ling-Wei Hsu, Christin Lee, Yan-Ting Chen, Sung-Chun Hsieh, Ping-yen Liu
Journal: Circulation (2022)

Introduction: Inhibition of renal sodium-glucose cotransporter-2 (SGLT2) reduces urinary glucose reabsorption to decrease glycemia. Recent large-scale trials have shown that SGLT2 inhibitors provide cardio protection beyond lowering glucose. Hypothesis: Treating SGLT2 inhibitor (SGLT2i) reduces the cardiovascular risk in type 2 diabetes that indicates the potential correlation of SGLT2i in cardiomyopathy mediating metabolic effects. Methods: Male 8 weeks old C57/BL6 mice were fed high fat diet (&gt; 60% of fat) for 4 months, and treated SGLT2i, canagliflozin (CANA) in the third and the fourth month. Measured its blood glucose, body weight and echocardiology every month. Moreover, analyzed the lipid contents in its plasma, the adipose tissue, liver and heart, and also examine the cardiomyopathy markers and its potential signaling pathways. Furthermore, palmitate acid (PA) was treated to H9c2 cells to mimic a high lipid environment, and validate its potential signaling pathways. Results: Treatments of high fat diet-induced obese mice with the CANA reduced blood glucose, body weight and adiposity. Moreover, CANA reversed the obesity-induced cardiomyopathy including heart weight ratio, echocardiology and cardiomyopathy markers ( Col1 , Col4 , Icam1 and Myh7 ). Furthermore, CANA increased AKT phosphorylation which is the one of the key pathways, and reduces apoptosis in cardiomyopathy. To investigate the potential mechanisms of metabolic changes in cardiomyopathy by CANA, we searched the hepatic RNA expression from high fat diet induced obesity mice by GEO profiles online. FGF21, a hepatokine increased in CANA action by hepatic and adipose tissue lipolysis, next circulated to the heart, and induced AKT phosphorylation to reduce apoptosis. CANA increased plasma and hepatic FGF21 in obese mice. Further treating recombinant FGF21 in H9c2 differentiated cardiomyocyte like cells with palmitic acid, FGF21 reduced cardiomyocyte apoptosis via AKT phosphorylation. Conclusions: These data demonstrated that SGLT2 inhibition ameliorates metabolic changes and apoptosis via FGF21-AKT pathway in cardiomyopathy.
Abstract 13759: Gender Differences in the Relationship Between Health Rating and Disruption of Medical Care in Atherosclerotic Disease Populations Due to COVID-19
Authors: Onoriode Kesiena, Aysha Allahverdiyeva, Navin Kumar, Shreyas Singireddy, Kofi D Seffah, Jacob Braunstein, Mehdi Rizvi, Kobina Hagan, Temitope Olokunlade, Syed Hyder, Reed Mszar, Elias Mossialos, Garima Sharma, Khurram Nasir
Journal: Circulation (2022)

Introduction: The COVID-19 pandemic reportedly disrupted access and delivery of healthcare across diverse populations. We evaluated gender differences in the relationship between health rating and the disruption of medical care in patients with atherosclerotic diseases (ASCVD) due to COVID-19. Methods: This was a cross-sectional study of 2,678 adults with ASCVD using the 2020 National Health Interview Survey data. Health status was rated as fair/poor, good, and very good/excellent. Medical care disruption due to COVID-19 were based on reports about a delayed medical care or not getting medical care at all due to COVID-19. Multiple logistic regression was used in this analysis with demographic, cumulative social risk, and comorbidities controlled for. Results: The mean (SE) age was 67.1 (0.4) and 42.8% were females. The distribution of the health rating of each gender by medical delay is shown in figure 1. Females who rated their health as fair/poor were more likely to delay care due to COVID when compared to those who rate their health as excellent [AOR 2.09 (95% CI 1.03, 4.24) p=0.040]. Males who rated their health as fair/ poor [AOR 1.50 (95% CI 0.85, 2.63) p=0.161] or good [AOR 1.27 (95% CI 0.75, 2.19) p=0.385] were not more likely to delay care due to COVID-19 when compared to those with an excellent health. Female who rated their health as fair/poor were more likely to not get care due do COVID-19 [AOR 2.35 (95% CI 1.14, 4.75) p=0.021]. However, males who rated their health as fair or poor [AOR 1.37 (95% CI 0.68, 2.74) p=0.375] or good [AOR 1.05 (95% CI 0.52, 2.11) p=0.887] were not more likely to not get care due to COVID-19 when compared to those with an excellent health rating. Conclusion: Among females, a fair/poor health rating was associated with either a delay or failure to get medical care. This can further worsen the gender disparity among ASCVD populations. Measures are needed to address this growing problem.
Abstract 14064: Utility of Tricuspid Annular Plane Systolic Excursion Normalized by Right Ventricular Size in Pulmonary Hypertension to Predict Exercise Capacity, Pulmonary Compliance, and Clinical Outcomes
Authors: Shannon E Heffernan, Ran Tao, Naga Dharmavaram, James Ma, Aurangzeb Baber, Ravi Dhingra, Sofia C Masri, Peter S Rahko, Raza Farhan
Journal: Circulation (2022)

1. Introduction: While tricuspid annular plane systolic excursion (TAPSE) captures the predominant longitudinal motion of right ventricle (RV), it may not accurately predict ventricular function as the RV dilates. Hence, normalizing TAPSE to ventricular area (in systole: TAPSE/RV-area-S, and diastole: TAPSE/RV-area-D) may lead to improved assessment of right heart function. In this study, we aim to determine the utility of RV size-indexed-TAPSE metrics in predicting exercise capacity and clinical outcomes. 2. Methods: We perform a retrospective analysis of 71 consecutive subjects undergoing invasive exercise hemodynamics with cardiopulmonary exercise test for evaluation of dyspnea. Patients were classified into four groups: pulmonary arterial hypertension, isolated post-capillary, combined pre-/post-capillary PH, and control (no PH) based on hemodynamic analysis. Transthoracic echocardiogram data included: TAPSE (mm), TAPSE-index-D (RV end-diastole area in cm), and TAPSE-index-S (RV end-systole area in cm). Subjects were followed for 12 months after hemodynamic study for adverse events (death, heart failure hospitalization). 3. Results: On ROC analysis of indexed-TAPSE to predict pulmonary compliance (&gt;3.0 ml/mmHg), we identified optimal cutoff of 1.1 for TAPSE-index-D (AUC=0.792, p&lt;0.001), 1.5 for TAPSE-index-S (AUC=0.827, p&lt;0.001), and 17 mm for TAPSE (AUC=0.672, p=0.005). Similar results were obtained for predicting %predicted VO 2 max (&gt;50%). We dichotomized indexed-TAPSE based on ROC analysis. As shown in the Figure, compared to the current recommended TAPSE cut-off of 17 mm, RV size-indexed TAPSE metrics were both superior in predicting adverse outcome (p&lt;0.01). 4. Discussion/Conclusion: Normalizing TAPSE to RV size can capture longitudinal and radial motion of the RV as the ventricle dilates and have better ability to predict clinical outcomes (death and HF hospitalization).